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Mental Health Care during Conflict: The Case of Colombia

Vaughan Bell, a clinical psychologist and the main force behind Mind Hacks, spent several years working with Médecins Sans Frontières in Colombia. The MSF (Doctors without Borders) program focused on health in rural areas, particularly those affected by civil combat, and Dr. Bell played a major role in helping to address mental health in those regions.

Background
Despite the fact that the Colombian armed conflict has continued for almost five decades there is still very little information on how it affects the mental health of civilians. Although it is well established in post-conflict populations that experience of organised violence has a negative impact on mental health, little research has been done on those living in active conflict zones. Médecins Sans Frontières provides mental health services in areas of active conflict in Colombia and using data from these services we aimed to establish which characteristics of the conflict are most associated with specific symptoms of mental ill health.

Methods
An analysis of clinical data from patients (N = 6,353), 16 years and over, from 2010–2011, who consulted in the Colombian departments (equivalent to states) of Nariño, Cauca, Putumayo and Caquetá. Risk factors were grouped using a hierarchical cluster analysis and the clusters were included with demographic information as predictors in logistic regressions to discern which risk factor clusters best predicted specific symptoms.

Results
Three clear risk factor clusters emerged which were interpreted as ‘direct conflict related violence’, ‘personal violence not directly conflict-related’ and ‘general hardship’. The regression analyses indicated that conflict related violence was more highly related to anxiety-related psychopathology than other risk factor groupings while non-conflict violence was more related to aggression and substance abuse, which was more common in males. Depression and suicide risk were represented equally across risk factor clusters.

Conclusions
As the largest study of its kind in Colombia it demonstrates a clear impact of the conflict on mental health. Among those who consulted with mental health professionals, specific conflict characteristics could predict symptom profiles. However, some of the highest risk outcomes, like depression, suicide risk and aggression, were more related to factors indirectly related to the conflict. This suggests a need to focus on the systemic affects of armed conflict and not solely on direct exposure to fighting.

This conclusion – that fighting itself is often not as bad as hardship and domestic abuse and other traumas that can fill every day – is one borne out in other research on adversity.

Bell drives this point home in his Mind Hacks post:

The study looked at how symptoms of mental illness were related to experience of direct conflict-related violence (exposure to explosives, threats from armed groups, deaths of loved ones etc), violence not directly related to the conflict (domestic violence, child abuse etc) and what we called ‘general hardships’ – such as economic problems and poor social support.

We predicted that the more someone was exposed to violence from the armed conflict, the worse mental health they would have, but what we found was a little different.

Experience of the armed conflict was more linked to anxiety while non-conflict violence was more related to aggression and substance abuse. Depression and suicide risk, however, were represented equally across all of the categories.

This is interesting because a lot of conflict-related mental health interventions are focused on trauma and PTSD, where as our study and various others have found that trauma is only one effect of being caught up in an armed conflict.

Hi Daniel
I am a social anthropology PHD student at Universidad de Los Andes in Colombia. As a member of the ethnopsychiatry research group at Universidad de Los andes we are very enthusiastic about your research and your endeavour (with Downey) towards neuroantrhopology as a new discipline and also as a promissing research line. I wonder if you are still intereseted in continue your research here in Colombia. We have been working (about 10 years) with mental illness (Schizo, PTSD, Affective disorders) and we have students (like me) designing their doctoral research projects following the envisioning framed by neuroantrhropology. Please let us know about how to follow your work in Colombia, and also it will be awesome if we can get in touch to let you share us your innovative trend within our academic landscapes